Ask Us Anything About… Stomach Pain

Scott Gilbert – From Penn State Health. This is ask us anything about stomach pain. I’m Scott Gilbert. You know, everyone gets a stomachache now and then and with any luck it’s gone within a few hours, right? Most causes of abdominal pain or not really cause her significant or deeper concern, but sometimes that pain can signal a more serious illness that does deserve medical attention. So, we want to talk about some of those conditions today and how you can possibly start to spot the difference. We’re going to do so with the help of Dr. David Ross, he’s a general surgeon at Penn State Health. Lancaster Medical Center. Dr Ross, appreciate your time today.

Dr. David Ross – Thanks for having me.

Scott Gilbert – You’re very welcome.  You know, like I mentioned, we all get stomachaches, right? You know, so we don’t want to cause alarm anybody and have them think that every stomachache is a problem. But what are the signs that are of serious stomach pain? Something that may indeed warrant medical attention.

Dr. David Ross – Sure! So, like you said, stomach pain is very common and can range from mild to severe. I would say that if you have pain that lasts for more than several hours that’s a warning sign that you should get some more immediate evaluation. If your pain is associated with other symptoms, like nausea and vomiting and fevers, any sort of acute change in bowel habits, these are all warning signs that maybe you should get a little bit more urgent evaluation. And if you have a little milder pain that, you know, comes and goes and doesn’t last very long and it’s tolerable and it doesn’t affect your daily activities. That could potentially be something that can be worked up in a more outpatient setting.

Scott Gilbert – And not to undermine the title of this interview, but we say stomach pain but not all of this pain originates in the stomach. Does it?

Dr. David Ross – No. When we say stomach pain? You know, that’s a very general term and what we clinicians typically talk about is abdominal pain. and abdominal pain is more any pain in this basically region from your chest to your pelvis. Many people will generalize this as stomach pain, but there’s a lot of different causes of this pain that don’t have anything to do with the stomach. So that’s a more general term.

Scott Gilbert – And so, there are different types of what we call stomach or abdominal pain. There’s a cute, there’s chronic and then there’s progressive, right? So that those latter two I think are especially of concern. Can you talk about the distinction between those and what those mean?

Dr. David Ross – Sure. So, acute abdominal pain would be something that basically pain that occurs with a sudden onset comes on very quickly. And is something that you’ve never experienced before. Chronic Abdominal pain is more pain that you experience on a regular basis. Sometimes it can be milder in nature. And so, it doesn’t affect, you know, people’s daily life enough for them to go in for evaluation right away. And then progressive abdominal pain is that’s basically saying that abdominal pain that starts a little more mild and becomes more severe over a short interval of time. Um And that’s another good warning sign that you should go in for evaluation. Probably quickly.

Scott Gilbert – Your watching ask us anything about stomach pain from Penn State Health. Dr David Ross is our guest. He’s a general surgeon at Penn State Health Lancaster Medical Center. And of course, we welcome your questions in the comment field of this Facebook post. So, feel free to add them there, whether you’re watching this interview live or even if you’re watching it on playback, we can make sure we get you answers to your questions because again, we know this is a topic that affects everybody to some extent. And again, Dr Ross, because we know we all experience stomach pain. What can we do as individuals to troubleshoot or even possibly pinpoint the source of stomach pain that we’re experiencing at a given time.

Dr. David Ross – Sure, some of the things that you know, we will ask on our initial evaluation will be, first of all, to characterize the stomach pain. Is it something that sharp? Is it dull? Where exactly is it located? The location of the stomach pain can be a very good indication of what the underlying problem may be. And so, the location when it began occurring, how frequently it occurs if there’s anything that makes it better or worse. These are all things that we use in our evaluation to help determine the underlying cause and the work up and treatment moving forward.

Scott Gilbert – You know, we as well, let’s get to some of the particular causes of stomach pain, that may not be those everyday causes. They may signal an underlying medical problem. You know, we talk about gallbladder problems about the source of stomach pain or abdominal pain. What exactly does the gallbladder do? And what does it mean when we say that this, this gallbladder ruptures or bursts?

Dr. David Ross – So, the gallbladder is an organ that attaches to one of the main ducts that drains the bile from your liver to your intestines and helps you digest food. The gallbladder works to store this bile and essentially move it into your intestines to help you digest after meals. So, one of the signs of problems with your gallbladder, which is one of the more common conditions that we deal with, is pain, especially in the right upper side of your abdomen that occurs primarily 30 minutes to an hour or two after eating. And this pain can either subside relatively quickly after or after an hour or two or it can persist for several hours. And which one of those things it does is dependent on the underlying, reason for the pain and will kind of determine how you should be evaluated from there.

Scott Gilbert – Now, I understand people can live without their gallbladder though. Right. What does that involve? Do you have to have medicine or something like that to replace its function?

Dr. David Ross – So, you can absolutely live without your gallbladder and you don’t typically need any medication to live without it. Your body is very good at adapting and it adapts typically relatively quickly to not having a gallbladder. Some people will experience some symptoms after the gallbladder is removed such as nausea or, or some sort of issues with their bowls. But most people don’t have any problems after the gallbladder is removed. And even if they do those problems typically resolve over time.

Scott Gilbert – Gallstones, we hear about those. I imagine you see some cases of those, what are they and what are they caused by? I mean, can we affect those? Can we cause those by what we eat?

Dr. David Ross – So, gallstones can sometimes form in the gallbladder and the formation is dependent on a variety of factors. Typically, it’s a combination of our diet and genetics. The majority of gallstones are made out of cholesterol. And so sometimes our diet can affect the formation of gallstones but not always. And the majority of gallstones that form in the gallbladder don’t cause any problems, but sometimes these stones can cause problems. And what they can do is they can get stuck, and they can block the gallbladder from emptying the bile. And that’s basically where the symptoms begin.

Scott Gilbert – You’re watching, ask us anything about stomach pain from Penn State Health. I’m Scott Gilbert alongside Dr. David Ross. He’s a general surgeon at Penn State Health Lancaster Medical Center and he’s here to answer your questions. In fact, we did get some questions in advance of this interview. Thanks to the promotional social media that we put out there and we’ll be sharing some of those very shortly. One of them having to do with hernias. So, before we get to that one, I do want to ask you just in general about you know what hernias are. I understand there are many different types, but in general, can you talk about what they are and what causes them?

Dr. David Ross – Sure. So, hernias in general are an opening in the strength layer of the abdomen, we call it the fashion. So, your abdominal wall has several layers, and the fashionable layer is the strength layer of the abdomen that basically keeps everything inside. And when you have an opening in this, sometimes things from inside the abdomen, typically fat or in some cases, other organs like your small intestine can herniated through these openings and cause problems ranging from pain to an obstruction of your intestines. And, so, as I mentioned, we did have a question about hernias. One of them came in from Sheryl. She’s asking what a hiatus hernia caused pain. Uh feeling like something is stuck in your throat like a pill and then cause excessive mucus to form in your mouth along with vomiting while exercising. Sounds like a number of different symptoms that play there. But is it possible that what Sheryl’s talking about could be caused by a hiatal hernia?

Scott Gilbert – Sure. And hiatal hernia is actually somewhat different in that it’s an opening or an enlargement of your diaphragm and where your esophagus becomes, your stomach can sometimes slide up in through that opening. And a small hiatal hernia typically does not cause any severe symptoms. But when these hernias become larger and especially if you know, a larger portion of your stomach is traveling through that hernia, you can certainly have those types of symptoms.

Dr. David Ross – Now, how are you as a surgeon position to take care of hernias? What are some of the solutions you bring forth to help people recover from them and I guess the procedures involved?

Scott Gilbert – Sure. So, hernias are something that can absolutely be repaired surgically. And with the, with how many different types of hernias there are along the abdominal wall or very commonly in the groin. This is something that we treat very often and there’s a couple different options for surgical repair. The traditional method of repairing these hernias was through an open incision and with the placement of a piece of mesh, which is basically a, a synthetic, a synthetic sheet that helps reinforce the hernia repair and prevent it from coming back. We now have more minimally invasive capabilities to repair many of these hernias. And typically, this results in a faster recovery with less pain, but it has to be very, you know, specialized to what type of hernia you have and your overall medical condition.

Dr. David Ross – We have another question from Chris, not related to hernias but something different. Chris asks us possible causes of chronic nausea, three months, fullness after eating small amounts, a distended stomach pain in the right side and center under the rib cage, no gallbladder, and sporadic vomiting and diarrhea. So, again, a real long list of symptoms there. And we always want to emphasize anytime people bring forth questions in this forum, we’re grateful. But ultimately, of course, Dr. Ross isn’t able to diagnose you on the spot that said Dr. Ross, when you hear about those symptoms, what goes through your mind?

Scott Gilbert – So, the first thing I think of if you’re having fullness after meals and your stomach is getting distended and you’re having pain is that it’s possible that your stomach isn’t emptying the way that it should be and there’s mechanical reasons for this and there’s physiologic reasons for this. And so, a good starting point would be to see your doctor and, and begin to work up to determine exactly which one of those underlying causes this could be if that is the case.

Dr. David Ross – Good advice you’re watching. Ask us anything about stomach pain from Penn State Health. I’m Scott Gilbert. He’s Dr David Ross, a general surgeon at Penn State Health Lancaster Medical Center. And we welcome your questions for him here in the comment field. And we hope that if you find this information to be helpful, you’ll hit the share button on this Facebook post and share it with your friends and followers. So, let’s shift gears here to diverticulitis and diverticulitis. They involve bulges in the wall of the colon. But first, can you talk about the difference in the condition in the between these two conditions? Because one I suppose, I guess you could say leads to another.

Scott Gilbert – Yes, that’s correct. So, diverticulitis, as you said, is essentially a condition where you have these bulges or pouches that form on the wall of the colon. And this can happen over time from typically a lack of fiber in the diet or, or anything that’s causing chronic pressure within the colon. And d diverticulitis can occasionally lead to diverticulitis, which is what we call it when those pouches become inflamed. And there is a wide range of severity of diverticulitis. Dr. David Ross – And it can be treated anywhere from having antibiotics prescribed by your primary care physician to requiring surgery depending on the severity.

Scott Gilbert – So, you know, when, when do we cross that line from treatable by antibiotics to requiring surgery? Because, you know, obviously, you know, perhaps, you know, medical intervention is most favorable to a lot of folks, but sometimes surgery is needed and often very successful for this.

Dr. David Ross – So, when surgery is required for diverticulitis, typically, in severe and acute cases, the diverticulitis,

Scott Gilbert – We still see you.

Dr. David Ross – Let me just get this light back on. Exactly! So, sometimes the inflammation can cause a perforation of these pouches and a perforation of the colon. And that’s basically a hole that forms in the wall of the colon. Now, if this is something that’s not contained by your body, which your body is very good at doing this.  And it’s making you very sick, you might need surgery right away for this. Another reason why surgery might be offered for diverticular disease. And diverticulitis is if you’re having recurrent episodes and it’s significantly affecting your life, or if you have any episodes where the diverticulitis is complicated by something like an abscess or some other complication. And we refer to that as complicated diverticulitis and generally what our goal is in these cases of complicated diverticulitis is to perform surgery electively. And this gives us the opportunity to essentially remove that part of the colon and reconnect the colon to itself and avoid something like a colostomy bag.

Scott Gilbert – What questions do you have about stomach pain? We’ll drop those in the comments section here because we’re talking with Dr David Ross. He’s a general surgeon at Penn State Health Lancaster Medical Center for this edition of, ask us anything about stomach pain. Some really good information here and again, just such a universal topic because we all experience it. Another one of those questions we got in advance of this interview came to us from Jackie. Jackie says four years ago, I had extensive bowel resection and Elias to me reversal. I now have pain daily and bowel issues due to scar tissue and alias doctors tell me there’s no help with surgery to remove it as it will come back worse. I feel hopeless. Is there hope for Jackie here? Do you have some advice for her?

Dr. David Ross – First of all, I would, you know, say sorry that this is something that she’s dealing with and is feeling this way, it’s a very difficult problem with surgery. Anytime that an operation is performed in the abdomen, there’s always the potential to form scar tissue and the scar tissue can oftentimes not cause any problems and sometimes it can cause problems like blocking the bowel from passing things through it. And can sometimes cause pain. The difficulty which she describes in her question is that any sort of operation to fix this could potentially create more scar tissue. What I would recommend is absolutely trying to find if there’s another underlying cause for the pain and the issues that she’s having. And then if there’s no other underlying cause that can be identified for the pain, it would have to be a discussion on the risks and benefits of removing scar tissue to potentially form more scar tissue. It’s a very difficult problem and it’s not very straightforward.

Scott Gilbert – Alright. Well, Jackie, thank you for your question and we wish you all the best. We hear about bowel obstructions. Bowel blockage is what causes those and how serious can those get and how do you treat those?

Dr. David Ross – So, the majority of bowel obstructions and what that means is that either your small or your large intestine is being partially or completely blocked by something from passing things through the most common reason for this when it’s the small intestine is adhesions and scar tissue from prior surgery. And when this is the case, sometimes, you know, these obstructions occur and, and most of the time when they happen, they will actually resolve with giving your balance time to rest and keeping you very well hydrated. You usually have to stay in the hospital for a few days. But most of the time this will resolve without any further surgery. Now, sometimes surgery is required if, if it doesn’t resolve or if there’s other potential causes for the obstruction. One of the other causes could be a hernia like we talked about earlier. And if small intestine gets stuck in the hernia, it can block things from moving through. And, and that’s typically something that should be fixed more urgently. The third cause of bowel obstruction and can occur in the large or small intestine would be the development of, of some sort of mass or cancer and those are the most common reasons.

Scott Gilbert – So, definitely something where people feel that they might have. It, it’s important to be seen by a professional because if it’s caused by especially the latter issue, you want to make sure that you’re seen as soon as possible. Again, you’re watching, ask us anything about stomach pain from Penn State Health in the last few minutes we have here. We welcome any questions you would have for Dr David Ross, he’s a general surgeon at Penn State Health Lancaster Medical Center. If someone’s stomach pain goes away when they stop eating gluten, does that automatically mean that they have celiac disease? Is that an if then scenario?

Dr. David Ross – It’s not a, it’s not an automatic diagnosis for sure. And if you’re concerned about having underlying celiac disease, I would highly recommend being seen so that she can be tested for it.

Scott Gilbert – Alright, sounds good. We’ll just to recap then Dr Ross, we want to leave people with a reminder of when to seek medical attention for their stomach pain. Remind us again, some of those symptoms that, um, would cross the line from routine stomach pain that can probably resolve with maybe over the counter antacids or whatever is something more serious.

Dr. David Ross – Right. So, any stomach pain, any abdominal pain that lasts for several hours, anything that is severe enough to affect your mobility or ability to perform your daily activities at home, any sort of pain that’s associated with fevers or nausea and vomiting or any change in your bowel habits. These are all warning signs that there could be a more serious underlying problem and should be evaluated and anything that you’re concerned about, you know, in, in general, we, we know our bodies very well and if it’s something doesn’t feel right, then my recommendation would be to go and see a professional about it.

Scott Gilbert – And we’ll make sure that we put contact information for how people can get in touch with physicians at Penn State Health about this issue. We’ll make sure we put that in the comment section below this Facebook post, Dr Ross. Thank you so much for your time today. It was great talking with you some really great advice about this important topic of abdominal pain. And we thank you for your questions and for watching, ask us anything about stomach pain from Penn State Health.

Dr. David Ross – Thank you very much.